Declining but Pronounced State-Level Disparities in Prescription Opioid Distribution in the United States.

The United States (US) opioid epidemic is a persistent and pervasive public health emergency that claims the lives of over 80,000 Americans per year as of 2021. There have been sustained efforts to reverse this crisis over the past decade, including a number of measures designed to decrease the use of prescription opioids for the treatment of pain. This study analyzed the changes in federal production quotas for prescription opioids and the distribution of prescription opioids for pain and identified state-level differences between 2010 and 2019. Data (in grams) on opioid production quotas and distribution (from manufacturer to hospitals, retail pharmacies, practitioners, and teaching institutions) of 10 prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) for 2010 to 2019 were obtained from the US Drug Enforcement Administration. Amounts of each opioid were converted from grams to morphine milligram equivalent (MME), and the per capita distribution by state was calculated using population estimates. Total opioid production quotas increased substantially from 2010 to 2013 before decreasing by 41.5% from 2013 (87.6 MME metric tons) to 2019 (51.3). The peak year for distribution of all 10 prescription opioids was between 2010 and 2013, except for codeine (2015). The largest quantities of opioid distribution were observed in Tennessee (520.70 MME per person) and Delaware (251.45) in 2011 and 2019. There was a 52.0% overall decrease in opioid distribution per capita from 2010 to 2019, with the largest decrease in Florida (-61.6%) and the smallest in Texas (-18.6%). Southern states had the highest per capita distribution for eight of the ten opioids in 2019. The highest to lowest state ratio of total opioid distribution, corrected for population, decreased from 5.25 in 2011 to 2.78 in 2019. The mean 95th/5th ratio was relatively consistent in 2011 (4.78 ± 0.70) relative to 2019 (5.64 ± 0.98). This study found a sustained decline in the distribution of ten prescription opioids during the last five years. Distribution was non-homogeneous at the state level. Analysis of state-level differences revealed a fivefold difference in the 95th:5th percentile ratio between states, which has remained unchanged over the past decade. Production quotas did not correspond with the distribution, particularly in the 2010-2016 period. Future research, focused on identifying factors contributing to the observed regional variability in opioid distribution, could prove valuable to understanding and potentially remediating the pronounced disparities in prescription opioid-related harms in the US.

Tecnologias em saúde e a produção de cuidados a pessoas que sofrem do coração / Technologies and Nursing Care Production for Heart Sufferers / Tecnologías y producción de cuidados de enfermería para los enfermos cardíacos

Esta pesquisa teve como objetivo cartografar a produção de cuidados da equipe de enfermagem a usuários que têm o coração em tratamento, em um hospital especializado do estado de São Paulo. O método escolhido foi o da cartografia, sob o referencial teórico da esquizoanálise. Os dados foram coletados por meio da observação participante, que possibilitou mapear o cuidado produzido pela equipe de enfermagem durante o caminhar da pesquisa. Pelas lentes cartográficas, avistaram-se mapas que revelaram um cuidado criativo, permeado por múltiplas tecnologias, emoções, subjetividades, afetos, ressentimentos e potencialidades. Observou-se que há uma produção de cuidados entre os profissionais de enfermagem junto ao paciente que sofre do coração, e neste cuidado há múltiplos fatores envolvidos, físicos, psíquicos, sociais, e que em um serviço de alta complexidade, os profissionais se apoiam em múltiplas tecnologias, articulando-as para promover um cuidado efetivo e individualizado.(AU)

This research aimed to map the care production of the nursing staff to users who have their heart in treatment, in a specialized hospital in the state of São Paulo. The method chosen was that of cartography, under the theoretical framework of schizoanalysis. Data were collected through participant observation, which made it possible to map the care produced by the nursing team during the research. Through the cartographic lenses, maps were revealed that revealed a creative care, permeated by multiple technologies, emotions, subjectivities, affections, resentments and potentialities. It was observed that there is a production of care among nursing professionals with the patient suffering from the heart, and in this care there are multiple factors involved, physical, mental, social, and that in a highly complex service, professionals rely on technologies, articulating them to promote effective and individualized care.(AU)

Esta investigación tuvo como objetivo mapear la producción de atención del personal de enfermería a los usuarios que tienen su corazón en tratamiento, en un hospital especializado en el estado de São Paulo. El método elegido fue el de cartografía, bajo el marco teórico del esquizoanálisis. Los datos fueron recolectados a través de la observación participante, lo que permitió mapear la atención producida por el equipo de enfermería durante la investigación. A través de las lentes cartográficas, se revelaron mapas que revelaron una atención creativa, impregnada de múltiples tecnologías, emociones, subjetividades, afectos, resentimientos y potencialidades. Se observó que existe una producción de atención entre los profesionales de enfermería con el paciente que sufre del corazón, y en esta atención hay múltiples factores involucrados, físicos, mentales, sociales y que en un servicio altamente complejo, los profesionales confían tecnologías, articulándolas para promover una atención eficaz e individualizada.(AU)

A Review of the Microbial Production of Bioactive Natural Products and Biologics.

A variety of organisms, such as bacteria, fungi, and plants, produce secondary metabolites, also known as natural products. Natural products have been a prolific source and an inspiration for numerous medical agents with widely divergent chemical structures and biological activities, including antimicrobial, immunosuppressive, anticancer, and anti-inflammatory activities, many of which have been developed as treatments and have potential therapeutic applications for human diseases. Aside from natural products, the recent development of recombinant DNA technology has sparked the development of a wide array of biopharmaceutical products, such as recombinant proteins, offering significant advances in treating a broad spectrum of medical illnesses and conditions. Herein, we will introduce the structures and diverse biological activities of natural products and recombinant proteins that have been exploited as valuable molecules in medicine, agriculture and insect control. In addition, we will explore past and ongoing efforts along with achievements in the development of robust and promising microorganisms as cell factories to produce biologically active molecules. Furthermore, we will review multi-disciplinary and comprehensive engineering approaches directed at improving yields of microbial production of natural products and proteins and generating novel molecules. Throughout this article, we will suggest ways in which microbial-derived biologically active molecular entities and their analogs could continue to inspire the development of new therapeutic agents in academia and industry.